health promotion of the preschooler

• Preschooler is ages 3-5 and they are preparing for school
• Experience brief and prolonged separation
• Use language and mental symbolization
• Increased attention span and memory

• Physical growth slows and stabilizes
• Average weight gain remains about 5lb/yr
• Average height increases 2.5-3 in/yr
• Body systems mature and stabilize; can adjust to moderate stress and change

• Gross motor: walking, running, climbing, and jumping well established
• Refinement in eye-hand and muscle coordination: drawing, artwork, skillful manipulation

• Erikson: Initiative vs Guilt
• Chief psychosocial task of preschool period
• Feelings of guilt, anxiety, and fear may result from thoughts that different from expected behavior
• Development of conscience (superego)
• Learning right from wrong, moral development

• Preoperational phase spans 2-7 years and is divided into two stages
• Preconceptual phase: 2-4 yrs
• Intuitive thought phase: 4-7 yrs
• Shifts from egocentric thought to social awareness
• Able to consider other viewpoints
• Egocentricity still evident

• Readiness for school and scholastic learning by age 5-6
• Language continues to develop
• Concept of causality beginning to develop
• Concept of time incompletely understood
• Continued use of "magical thinking"

• Basic level of moral judgement leading to a punishment and obedience orientation
• Naive instrumental orientation- actions to satisfy own needs and less concern of needs of others
• Concrete sense of justice and fairness

• Knowledge of faith and religion learned from significant others and religious practices
• Development of conscience strongly linked to spiritual development
• May interpret illness as punishment from God

• Increasing comprehension of "desirable" appearance
• Aware of racial identity, differences in appearances, and biases
• Poorly defined body boundaries: fear that if skin is "broken" all the blood and insides will come out
• Frightened by intrusive experiences

• Form strong attachment to the opposite-sex parent while identifying with the same-sex parent
• Become concerned with modesty
• Sex role imitation, "dressing up like mommy or daddy"
• Sexual exploration more pronounced
• Questions arise about sexual reproduction

• Individualization-separation process is completed
• Overcome stranger anxiety and fear of separation from parents
• Still need parental security and guidance
• Security from familiar objects
• Play therapy beneficial for working through fears, anxieties, and fantasies

• Major mode of communication and social interaction
• Vocabulary increases dramatically between ages 2-5 yrs
• Complexity of language uses increases between 2-5 yrs (3-4 yr means 3-4 word sentences, 5+ word sentences by age 5)

• Associative play (group play with goals and organization)
• Imitative play
• Imaginative play and playmates
• Dramatic play
• *Limit TV and computer time

• Self-dressing
• Willing to please
• Have internalized values and standards of family and culture
• May begin to challenge parental values

Developmental screening tools may be used in preschool and kindergarten, however there is no absolute indicator

• Find out what the children already know and think
• Be honest
• Avoid over-answering the question
• Sexual exploration and sexual curiosity

• Dark
• Being left alone
• Animals
• Ghosts
• Objects or persons associated with pain
• Techniques for desensitization should be used to overcome fears

• Minimum amounts of stress can be beneficial
• Parental awareness of signs of stress in child;s life
• Prevention of stress
• Schedule adequate rest
• Prepare child for upcoming changes to maximize coping strategies

• Aggression is any behavior that attempts to hurt person or destroy property
• May be influences by biologic, sociocultural, and familiar variable
• Factors that increase aggressive behavior include gender, frustration, modeling, and reinforcement 
• Positive reinforcement works better than negative reinforcement

• Stuttering and stammering
• Dyslalia: articulation problems
• Denver Articulation Screening Examination (DASE) tool for assessing speech problems

• Caloric requirements are approx 90 kcal/kg wit <30% of diet being fat
• Fluid requirements approx 100 ml/kg depending on activity and climate
• Children like one food (food fads) and have strong tastes
• Consume about 50% of an adult size portion

• 12 hrs of sleep per night with infrequent naps
• Consistent bedtime routine
• May have nightmares or sleep terrors (occur in the first few hours of sleep)

• Eruption of deciduous teeth is complete
• Professional care and prophylaxis to prevent caries
• Nutrition to prevent caries
• Child learning to brush teeth with parent's help
• May need fluoride supplements (controversial)

• Safety education for the child:
• Stranger danger teaching
• How to interact with animals
• Good touch vs bad touch teaching
• Car and road safety
• Firearm safety
• Bike safety
• Fire safety
• Complete annual physical exams and immunizations

• Childcare focus shifts from protection to education
• Children begin questioning previous teachings of parents
• Children begin to prefer companionship of peers, but still need their patients